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When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country

To investigate the burden and causes of life‐threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals.

Morbidity and mortality in booked women who deliver outside orthodox health facilities in Calabar, Nigeria.

Women who booked for antenatal care at the University of Calabar Teaching Hospital (UCTH), Calabar, but delivered outside orthodox health facilities were studied. The aims were to determine the pattern of maternal morbidity and mortality in them and to compare this with the pattern in women who booked and delivered at UCTH. One hundred and eighteen of the defaulters traced (35.1%) had complications compared with 34 (10.1%) of the control. Only 32.2% of these defaulters with complications presented in orthodox health facilities for treatment. The major complications in the study group were: perineal tear (19.0%); primary postpartum haemorrhage (12.5%); and puerperal sepsis (5.4%). These were significantly higher in the study group than in the controls (P<0.001). Maternal mortality ratio of 6.0 per 1000 live births was recorded in the study group, but there was no death in the control. Health education and public enlightenment campaigns emphasising universal antenatal care along with delivery in orthodox health facilities are strongly advocated.

Perinatal outcome in pregnancies booked for antenatal care but delivered outside health facilities in Calabar, Nigeria ☆

Pregnancies that were booked for antenatal care but delivered outside the health facilities were studied. The aim was to determine the perinatal outcome of these pregnancies, and also to compare the outcome with that of pregnancies that were booked and delivered in the University of Calabar Teaching Hospital (UCTH). Birth asphyxia was the commonest perinatal morbidity in both the study (14.3%) and control (4.8%) groups and was significantly higher in the study group than in the control (P < 0.01-P < 0.05). Incidence of neonatal infection tetanus and birth trauma was also significantly higher in the study than in the control groups (P < 0.01-P < 0.05). The incidence of prematurity, neonatal jaundice and congenital abnormality did not show any significant difference in the two groups (P > 0.05). The risk of perinatal death was three times higher in the study group than in the control. Proper public enlightenment campaigns and the establishment of a national health insurance scheme which may strengthen the use of orthodox health facilities for delivery, may improve the poor perinatal outcome in our community.

Congenital malaria in Calabar, Nigeria: the molecular perspective.

Polymerase chain reaction (PCR) has been shown to be more sensitive in detecting low-level parasitemia than conventional blood film microscopy. We estimated the prevalence of congenital malaria using nested PCR amplification of the small subunit 18S RNA gene to detect low-level parasitemia and identify Plasmodium species in 204 mother-neonate pairs. Cord-blood parasitemia was detected in four babies by PCR, giving a prevalence of 2.0%. The newborns of primidgravidae were more susceptible to congenital malaria than those of multigravidae (P < 0.0001). There was a strong correlation between placental malaria and congenital malaria (odds ratio = 10.1, 95% confidence interval = 1.3-76.1, P = 0.0487). We conclude that the prevalence of congenital malaria in Calabar detected by PCR is lower than has been reported in this environment through microscopy.

Knowledge, Attitude and Practice of Private Medical Practitioners in Calabar towards Post-Abortion Care

This study examined the knowledge, attitude and practice of private medical practitioners in Calabar on abortion, post-abortion case and post-abortion family planning. Forty eight private practitioners who were proprietors of private clinics in the city were interviewed using a structured questionnaire. The results showed that 22.9% of the doctors routinely terminate unwanted pregnancies when requested to do so by women, while 83.3% of them treat women who experience complications of unsafe abortion. The major reasons given by some of the doctors for not terminating unwanted pregnancies were religious, moral and ethical considerations rather than respect for the Nigerian abortion law. Only 18.2% of the doctors use standard procedures such as manual vacuum aspiration (MVA) for the management of patients with abortion and abortion complications. A good number of them did not routinely practice integrated post-abortion family planning and STDs management. There is need for a comprehensive programme of retraining of private medical practitioners in Calabar on the principles and practices of safe abortion, post-abortion care and family planning. These aspects of reproductive health need to be integrated into the medical training curricula in Nigeria. It is believed that this approach would help reduce the present high rate of abortion-related morbidity and mortality in Nigeria.

Socio-demographic and reproductive characteristics of women who default from orthodox obstetric care in Calabar, Nigeria.

This study was designed to identify the socio-demographic and reproductive characteristics of women in Calabar Nigeria who booked for antenatal care at the University of Calabar Teaching Hospital (UCTH) but delivered in unorthodox delivery facilities. Study participants comprised women who gave birth via unorthodox delivery while the control population comprised women who completed antenatal care and gave birth at UCTH or any orthodox health facility. Overall the results noted a greater tendency of young women to default from orthodox obstetric care than older women with the church being the most preferred facility by these unorthodox antenatal clinic defaulters. Moreover any woman who had a vaginal delivery in her previous pregnancy is young and nulliparous is of low socioeconomic class from an indigenous population in Calabar and worships in a spiritual church is likely to default from orthodox obstetric care. Hence there is a need for one-on-one education and counseling of these women in antenatal clinics. Above all general improvement in socioeconomic status by creating employment opportunities and reducing cost of living would ameliorate the poverty factor which appears to contribute to the high defaulting rate.

Relative risk of birth asphyxia in babies of booked women who deliver in unorthodox health facilities in Calabar, Nigeria.

Babies of booked women who delivered in unorthodox health facilities in Calabar, Nigeria were studied. The aims were to determine the relative risk of birth asphyxia in these babies and to find out the management of birth asphyxia in these unorthodox delivery centres. The incidence (14.3%) of birth asphyxia in the study population was significantly higher than the incidence (4.8%) in babies of booked women who delivered in the University of Calabar Teaching Hospital (P < 0.001) with a relative risk of 3.0 (95% C.I.=1.74-5.19). Apart from prolonged labour, the predisposing factors to birth asphyxia in both the study group and control did not show any significant difference (P > 0.05). The treatment of birth asphyxia in unorthodox delivery centres consisted mainly of prayers (43.8%) and immersion of the asphyxiated baby in cold water (25%). A birth asphyxia case fatality rate of 20.8% was recorded in these unorthodox delivery facilities but no death in the control population. Appropriately directed antenatal health education on the benefit of delivering under supervision of trained personnel is strongly advocated.

Impact of Mass Media Campaigns on the Knowledge and Attitudes of Pregnant Nigerian Women Towards HIV/AIDS

A total of 508 women coming for antinatal care had a structured interview about the risk factors for HIV/AIDS. While most knew about HIV and that it could be transmitted sexually, knowledge of mother-to-child transmission was poor. Only 23% knew that HIV could be transmitted by breast milk. In all, 85% would not care for a relative with AIDS.

The National Breastfeeding Policy in Nigeria: The Working Mother and the Law

In this article, we examine the National Breastfeeding Policy in Nigeria, the extent to which the law guarantees and protects the maternity rights of the working mother, and the interplay between the law and the National Breastfeeding Policy. Our aim is to make people aware of this interplay to lead to some positive efforts to sanitize the workplace and shield women from some of the practices against them in employment relations in Nigeria as well as encourage exclusive breastfeeding by employed mothers. We conclude that the provisions of the law in this regard are not in accord with the contemporary international standards for the protection of pregnancy and maternity. It does not guarantee and protect the freedom of the nursing mother to exclusively breastfeed the child for at least the 6 months as propagated by Baby Friendly Hospital Initiative (BFHI) and the National Breastfeeding Policy. Moreover, there is no enabling law to back up the National Policy Initiative as it affects employer and employee relations. We, therefore, suggest a legal framework for effective implementation of the National Breastfeeding Policy for women in dependent labour relations. It is hoped that such laws will not only limit some of the practices against women in employment but also will encourage and promote exclusive breastfeeding behaviour by employed mothers.

The influence of cultural practice on puerperal anemia

Puerperal anemia is one of the main causes of maternal morbidity and mortality in Nigeria and other developing countries [l]. This is probably due to the high incidence of obstetric hemorrhage. It is not always possible to successfully treat the anemia before discharge from the hospital as most of the health institutions in developing countries do not have blood transfusion services. Even where the blood transfusion services exist, the response of the population to blood donation is usually discouraging. Hence most of the patients are usually discharged from the hospital with hemoglobin less than 10 g%. In the south-eastern region of Nigeria where Calabar is situated, women are culturally given intensive nutritional care after delivery in preparation for the ‘outing’ ceremony. The local foodstuffs used are rich in iron and folic acid. The foodstuffs include green vegetables, yams, plantain, fish and other aquatic protein foodstuffs. The aquatic protein sources are edible snails (J4~uparu quadrutu), periwinkle (Lifhotiru littoreu), crayfish (Pulumonettes uiuiuns), and clam (Egreriu